Financial Assistance Policy Effective Wheeling Hospital

Transcription

1 Financial Assistance Policy Effective Wheeling Hospital Responsibility Financial Assistance is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with Wheeling Hospital s procedures for screening the patient s ability to pay and whether they may qualify for financial assistance. Definitions For the purpose of this policy, the terms below are defined as follows: Medically Necessary defined as any hospital inpatient, outpatient, or emergency medical care that is needed for the diagnosis or treatment of your medical condition, meet accepted standard of medical practice, and is not entirely elective for patient comfort and/or convenience. Charity Care defined as healthcare services that have been or will be provided but are never expected to result in payments. Charity care results from a provider s policy to provide healthcare services free to those approved applicants who are at or below 200% of the Federal Poverty Guidelines. Financial Assistance medically necessary care provided by Wheeling Hospital to those approved applicants who are between 201% and 400% of the Federal Poverty Guidelines. Federal Poverty Level (FPL) defined as the set minimum amount of gross income that a family needs for food, clothing, transportation, shelter and other necessities. Amounts Generally Billed (AGB) defined as the amounts generallly billed to insured patients seeking emergency or medically necessary care Gross Charges defined as the total charges at the organization s full established rates for the provision of patient care services before deductions from revenue are applied. Patient Income defined as the previous year total income and will include: wages, unemployment compensation, workers compensation, Social Security, Supplemental Security Income, public assistance, veterans payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, alimony, child support, assistance from outside the household, and other miscellaneous sources; - Noncash benefits (such as food stamps and housing subsidies) do not count - Excludes capital gains or losses - If a person lives with a family, include the income of all family members (nonrelatives, such as housemates, do not count). Family defined as the parent, spouse, and all children, natural or adoptive, under the age of eighteen who live in the home. Uninsured defined as a patient with no level of insurance or third party assistance to assist with meeting his/her payment obligations. Eligibility All Wheeling Hospital accounts for inpatient, outpatient, emergency room services, and professional services of employed physicians are eligible for financial assistance or charity care. Eligibility is to be determined by referencing the Financial Assistance/Charity Care matrix, which is based on the Federal Poverty Guidelines for the most current year available as issued by the department of Health and Health Services. An application must be completed by the patient/guarantor. Each application received will serve to determine eligibility for all *family members listed within the application. The completed

2 application must be signed by the patient/applicant or the responsible party attesting to the truthfulness and accuracy of the information provided on the application. When a patient has provided the completed application, the Patient Accounting Supervisor/Manager or the Revenue Cycle Director can approve the application. Patients will be required to re-verify and re-submit a completed application for charity or financial assistance every 180 days. In the event that a patient has been approved for Medicaid but has services that Medicaid has not agreed to back date coverage for or has services that fall outside of the 3 month back date window, those patient s services will be eligible for a charity adjustment, provided the patient fills out a financial assistance application. They will receive a letter from the business offices acknowledging that services have been adjusted as well as what account numbers and related dates of services that were affected; however, these patients will not receive a charity card from the business office. Any person found to be providing fraudulent information will be denied without reconsideration for a period of up to one year. *Grandparents are permitted to include grand children that reside with them on their charity or financial assistance application, if they are able to claim them on their federal tax return. Method of Billing Charges Uninsured Patients Wheeling Hospital will assist uninsured patients in applying for charity care and/or financial assistance or other medical coverage. These patients will be encouraged to undergo a screening for Medicaid eligibility with our financial counselors to determine if they qualify for Medicaid coverage. Uninsured patients will be granted a discount from total charges at the time of the initial billing. After a patient has submitted their charity or financial assistance application and it has been determined that they qualify for assistance, Wheeling Hospital then reviews any accounts that need to be adjusted. The adjustments to the accounts are applied using the methods outlined below. Inpatient discount off AGB charges billed 201% - 300% 35% discount 301% - 350% 25% discount 351% - 400% 15% discount Outpatient discount off AGB charges billed 201% - 300% 30% discount 301% - 350% 20% discount 351% - 400% 10% discount Wheeling Hospital utilizes the look-back method to determine the amounts generally billed (AGB) to determine the charges billed to patients that qualify for participation in the financial assistance program. Inpatient and outpatient services were calculated separately. The percentages were determined by utilizing the calculation of the sum of all claims paid by Medicare fee for service and all

3 private health insurers divided by the sum of the gross charges for these claims. Inpatient service percentage is 48% and outpatient service percentage is 48% for calendar year These accounts will not be eligible for the prompt-pay discounts offered by Wheeling Hospital. Method of Billing Charges Insured Patients Wheeling Hospital will assist insured patients with patient due balances, as a result of deductible, copays, or co-insurances assigned by the insurance provider, in applying for charity care and/or financial assistance. After a patient has submitted their charity or financial assistance application and it has been determined that they qualify for assistance, Wheeling Hospital then reviews any accounts that need to be adjusted. The adjustments to the accounts are applied using the methods outlined below. Discount 201% - 225% 65% discount 226% - 250% 60% discount 251% - 275% 55% discount 276% - 300% 50% discount 301% - 325% 45% discount 326% - 350% 40% discount 351% - 375% 35% discount 376% - 400% 30% discount These accounts will not qualify for the prompt-pay discounts offered by Wheeling Hospital. Method of Application In order to apply for charity care and/or financial assistance, the application provided must be filled out in its entirety and submitted to the Wheeling Hospital business office. Upon approval of the patient s application, a card will be issued by the Patient Accounting Office and is good for 180 days. The card is accepted at both Wheeling Hospital and Belmont Community Hospital for that 180 day time period. All unpaid balances currently a part of the hospital s accounts receivable will be adjusted as charitable or financial assistance eligible. Any balance that was deemed bad debt for a period up to 12 months prior to the date of approval will be adjusted as charitable or financial assistance eligible. A patient will be required to update their financial information and fill out a new charity or financial assistance application after the 180 day period expires. *Family shall include the patient(s), their spouse, and all children, natural or adoptive, under the age of eighteen who live in the home. If a patient is in need of any assistance regarding the charity/financial assistance program or the related applications, they are encouraged to contact the Wheeling Hospital business office at if their last name is between A and K or the Wheeling Hospital business office at if their last name is between L and Z. Method of Application through Financial Counselors

4 Upon registration for outpatient services, if a patient expresses concern in regard to payment, whether for co-pay, co-insurance, or deductible, the financial counselors will offer and explain the hospital s charity and discount application. If a patient is interested in applying for charity, the financial counselor has the ability to run the patient through inroads. The inroads software will calculate if a patient/spouse/children qualify for Medicaid. In the event that the pt/spouse/children qualify, the financial counselor will send them to the correct DHHR office to complete the application process for the Medicaid card. If they do not qualify, then the financial counselor will utilize the denial from inroads as part of the charity application, showing that the patient has no insurance and does not qualify for governmental assistance. The financial counselors will then inquire about the patient s gross family income. This inquiry will give the financial counselor an idea of where the patient would fall on the charity/discount scale and gives the financial counselor an opportunity to tell the patient what they could qualify for, even before the application is processed. The financial counselors would then indicate that the patient should fill out the application. At this time, the financial counselor will tell the patient to send their application through the mail or drop them off to their office. They will also make themselves available for any questions that the patients may have. Once the financial counselor verifies that the application is completed, they will scan it to the patient accounting supervisor or the patient accounting director for signature approvals. The patient accounting supervisor and the patient accounting director will approve and return to the financial counselors so that they can contact their patients with the approval as well as making them aware that their cards will be sent to them in the mail. Once the cards are received in the mail, they are good for 180 days. All unpaid balances currently a part of the hospital s accounts receivable will be adjusted as charitable or financial assistance eligible. Any balance that was deemed bad debt for a period up to 12 months prior to the date of approval will be adjusted as charitable or financial assistance eligible. A patient will be required to update their financial information and fill out a new charity or financial assistance application after the 180 day period expires. Billing and Collection Wheeling Hospital has a separate billing and collections policy and it will be made available, upon request, to the patient. Affiliated Entities Wheeling Hospital is affiliated with several small groups representing anesthesiologists, radiologists, hospitalists, and emergency room physicians. First Capitol Emergency Physicans employs and bills for the services provided by the emergency room physicians. Radiology Associates employs and bills for the services provided by the radiologists. Medical Park Anesthesiologists employ the anesthesiologists and MBA bills for the services provided. Mountain Emergency Physicians, LLP employs and bills for the physicians in the hospitalists group. One or more of these groups may provide medically necessary services to our patients when the patient is in the emergency room, receiving inpatient or outpatient services; however, these groups are not covered under our Financial Assistance Policy. First Capitol Emergency Physicians, Radiology Associates, Mountain Emergency Physicians and MBA (Medical Park Anesthesiologists) honor the Wheeling Hospital charity/discount determinations if a patient provides the billing office(s) with a copy of the charity/discount card. However, the level of discount may not be the same as the level of discount offered by Wheeling Hospital. Policy Publication

5 The Financial Assistance Policy can be found on Wheeling Hospital s website, as also located on the website, patients can find the charity/financial assistance policy application and a plain language summary of the charity/financial assistance policy. At the request of the patient, the hospital will send all or some of the documentation through the mail. Paper copies can also be found on the hospital grounds at several locations. At the time of discharge, included in the discharge papers, the patients will receive a plain language summary of the charity/financial assistance policy as well as a copy of the discount/charity application and the related contact numbers for assistance or questions on filling out the forms. Patients may find the Charity Care/Financial Assistance application located on the back of their billing statement as well. On site, patients can find displays of the charity/financial assistance policy located in the ER lobby, as well as the lobby of the outpatient registration department and on the walls of the registration booths and financial counselors offices. At the time patients are seen, they are encouraged to inquire about the charity/financial assistance policies and whether or not they may qualify for assistance. The registrars and financial counselors will also have access to paper copies of the plain language summary, charity application, and financial assistance policy, should the patient wish to review the policies on their own and ask questions later. Additional Information In some cases, Wheeling Hospital may recognize other financial or medical conditions that warrant financial assistance. If a patient s income falls outside the guidelines for financial assistance/charity care, please contact Wheeling Hospital s business office at (800) in order to review circumstances and options. In any case, Wheeling Hospital staff may be able to help establish a payment plan that helps patients pay their balance(s), over time. Exclusions While Wheeling Hospital s Charity/Financial Assistance Program covers most services, there are some exclusions, including, but not limited to cosmetic surgeries, unless medically necessary, and any other services, at Wheeling Hospital s discretion. Long-term care and ICF services provided at Bishop Joseph Hodges Continuous Care Center are not subject to charity or discount adjustments, payment arrangements must be made with the staff at Bishop Joseph Hodges Continuous Care Center. Refunds If a patient has made any payments to Wheeling Hospital toward an outstanding balance, prior to filling out a financial assistance application, those payments will not be subject to refund. The balances due to the hospital will be adjusted, according to payment made, and any financial assistance adjustment will be made on the balance(s) outstanding.